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Structure

Ureter

Not medically reviewed · Content last updated · 2 min read ·

This is the date the draft was written, not a medical review date.

The ureter is a muscular tube that carries urine from the renal pelvis to the urinary bladder by peristalsis. It is about 25 cm long in adults (approximate) and has three classic narrowings.

Terminologia Anatomica (Latin): Ureter · Open in the 3D atlas

Location

It descends retroperitoneally on the psoas major, crosses the pelvic brim at the bifurcation of the common iliac artery, then runs down the lateral pelvic wall and turns medially to enter the bladder obliquely. It is therefore described in abdominal and pelvic parts.

Structure

The wall has a transitional epithelium (urothelium), a smooth muscle layer (inner longitudinal, outer circular, with an extra outer longitudinal layer distally) and an adventitia. The three narrowings are the pelviureteric junction, the pelvic brim (crossing of iliac vessels) and the vesicoureteric junction, which are common sites for stone impaction.

Blood supply

Supply is segmental: renal and gonadal arteries proximally, branches of the common iliac and internal iliac arteries in the pelvis, and the inferior vesical artery (or uterine artery in women) distally. Venous and lymphatic drainage follow the arteries, with lymph reaching the para-aortic and iliac nodes.

Innervation

Autonomic fibres arrive from the renal, aortic and hypogastric plexuses (sympathetic T10-L2, parasympathetic S2-S4 to the pelvic part). Pain from stone obstruction is referred along the loin to groin and genitalia (T11-L2, ilioinguinal and genitofemoral territories).

Function

The ureter propels urine to the bladder by peristaltic waves, independent of gravity. The oblique intramural course through the bladder wall acts as a one-way valve that limits vesicoureteric reflux.

Clinical correlations

Ureteric colic from calculi is typically worst at the three narrowings. The ureter lies close to the uterine artery (water under the bridge) and the ovarian vessels, so it is at risk of injury in hysterectomy and pelvic surgery. Congenital variants include duplex systems and pelviureteric junction obstruction.

Common exam points

  • Three narrowings: pelviureteric junction, pelvic brim, vesicoureteric junction.
  • In the pelvis the ureter passes under the uterine artery (female) or the ductus deferens (male).
  • Lies on the anterior surface of psoas major; the gonadal vessels cross it anteriorly.
  • Colic pain radiates from loin to groin (T11-L2).
  • Oblique intramural course prevents reflux.

References

  1. Drake RL, Vogl AW, Mitchell AWM. Gray's Anatomy for Students. Elsevier — Tier 3 (textbook)
  2. Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. Wolters Kluwer, 8th edition (2018) — Tier 3 (textbook)
  3. Brenner and Rector's The Kidney. Elsevier, 11th edition (2019) — Tier 3 (textbook)

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